High-Quality Nursing Homes Lower Risks for Long-Term Care Placement for Older Adults

Journal of the American Geriatrics Society Research Summary

After being discharged from the hospital, an older person often is admitted directly to a skilled nursing facility (SNF). SNFs specialize in the skilled care we need to recover properly.  These facilities also provide the additional rehabilitation we may need before returning home. However, experts have raised concerns about the uneven quality of SNF services, the substantial differences among them, and how they are used in different parts of the country. A transfer from an SNF to a long-term care facility, for example, is considered a failure to achieve the goals of SNF care.  Most older people view a move to a long-term care facility as a step in the wrong direction.

In a new study, researchers decided to examine the role that SNFs play with regard to older adults’ placements in long-term care facilities. Their study was published in the Journal of the American Geriatric Society.

The researchers studied the role of SNF quality and how it affected older adults’ risks of transitioning to long-term care facilities. They also looked at whether any aspects of skilled nursing were linked with an older adult’s risk of entering long-term care facilities. The research team focused specifically on whether the quality ratings of SNFs (available to the public, free of charge, here) helped predict long-term care placements. Continue reading

Should Older Adults with Diabetes Maintain Tight Blood Sugar Control?

Journal of the American Geriatrics Society Research Summary

More than 25 percent of adults aged 65 or older have diabetes. Diabetes develops when the amount of sugar (or glucose) in your blood becomes too high. This happens either because your body doesn’t make enough insulin (type 1 diabetes), or because your body doesn’t respond to the insulin it makes (type 2 diabetes).

Older adults are especially likely to develop type 2 diabetes, because as we age, our bodies are less able to process sugars. What’s more, being overweight can increase our chances of developing the condition.

If you’re an older adult with type 2 diabetes, it’s likely that your healthcare provider has recommended that you carefully maintain your blood sugar levels with diet, exercise, and perhaps even medication. Blood sugar levels are typically monitored with a simple blood test that gives you a result called your “A1c level.” This is the percentage measurement of glucose levels in your blood over about three months.

But what should your target blood sugar level (A1c) be? If it’s too low, you could be at risk for hypoglycemia, or low blood sugar. When this occurs, you can fall or lose consciousness.

In a new study published in the Journal of the American Geriatrics Society, researchers say the evidence against “tightly” controlling blood sugar levels for older adults—the practice of targeting a more specific A1c level, often through the use of medications—hasn’t filtered down to clinics and primary care practices, where there may be value in pursuing looser target levels for blood sugar.

In their study, researchers examined records from the Diabetes Collaborative Registry for more than 30,000 adults aged 75 or older. In the study, 26 percent of older adults with diabetes had A1c levels less than 7 percent. They were treated with medications that have a high risk for lowering blood sugar to the point that someone could be at increased risk for a fall or losing consciousness.

Contrary to what researchers thought, these factors were each linked to having tight blood sugar control using a “high-risk” medication: older age, being male, or having heart failure, chronic kidney disease, and coronary artery disease. According to the researchers, people with these characteristics or conditions have the most potential to be harmed if they experience hypoglycemia and their A1c goals should be more relaxed.

The researchers concluded that we need more specific guidance about how to safely treat older adults with diabetes, and that we need to translate that guidance to help busy clinicians and their patients.

 This summary is from “Use of Intensive Glycemic Management in Older Adults with Diabetes.” It appears online ahead of print in the Journal of the American Geriatrics Society. The study authors are Suzanne V. Arnold, MD, MHA; Kasia J. Lipska MD; Jingyan Wang MS; Leo Seman, MD PhD; Sanjeev N. Mehta MD, MPH; and Mikhail Kosiborod MD.

Can a Neighborhood Affect an Older Adult’s Health?

Journal of the American Geriatrics Society Research Summary

According to a new study published in the Journal of the American Geriatrics Society, living in socially and economically disadvantaged neighborhoods can have a negative influence on older adults’ health and well-being.

Older adults who live in disadvantaged neighborhoods report having poorer health and have more difficulty getting around and performing daily tasks. What’s more, older adults living in disadvantaged neighborhoods tend to have more chronic illnesses and higher rates of death than do older adults who live in less disadvantaged neighborhoods.

Many issues affect the relationship between neighborhoods and health. One may be that disadvantaged neighborhoods have lower levels of social support for older adults and their caregivers. These neighborhoods also tend to have fewer physical resources, such as access to health care, retail stores, and recreational facilities.

Social and other resources are important for older adults. Therefore, older adults living in disadvantaged neighborhoods may find it harder to maintain well-being while aging. This can make it challenging for our society as a whole to benefit from our increased longevity.

The research team who conducted the study used the 2013 Medicare Health Outcome Survey (HOS) survey. This is a telephone and mail survey that was given to older adults enrolled in Medicare Advantage (MA) health plans (MA plans are insurance plans offered by private companies approved by Medicare). Around 17.6 million people are enrolled in MA plans. This is 31 percent of the population eligible for Medicare (the government program that provides health insurance to people 65-years-old and older). Information about 187,434 older adults was included in the study.

The researchers concluded that disadvantaged neighborhoods are an important predictor of mobility and other limitations among MA beneficiaries, particularly for those with multiple chronic conditions. Compared to those living in less disadvantaged neighborhoods, MA beneficiaries who have multiple chronic conditions and who live in the most disadvantaged neighborhoods are 12 percent more likely to report difficulty performing at least one daily task, such as bathing, dressing, or keeping house.

The researchers suggested that increasing resources in disadvantaged neighborhoods to support health programs for older adults could improve their health outcomes.

This summary is from “Linking Neighborhood Context and Health in Community-Dwelling Older Adults in the Medicare Advantage Program.” It appears online ahead of print in the Journal of the American Geriatrics Society. The study authors are Daniel Jung, BS; Amy Kind, MD, PhD; Stephanie Robert, MSW, PhD; William Buckingham, PhD; and Eva DuGoff, PhD, MPP.

Having Multiple Chronic Illnesses Plus Functional Limitations Increases Risk of Death among Older Adults with Heart Failure

Journal of the American Geriatrics Society Research Summary

Heart failure affects more than 6 million people in the U.S.—most of whom are older adults. Roughly half the older adults who have heart failure also live with five or more other chronic health conditions. This group of people may have difficulty performing daily activities, such as walking, bathing, and eating. And older adults who have multiple chronic illnesses plus heart failure generally require more frequent health care, including more visits to healthcare providers and hospitalizations.

Recently, researchers examined the impact of having multiple chronic conditions and having difficulty with daily activities on the health of older adults with heart failure. Until now, there’s been no research on the combined effects of having all three problems for older adults. The researchers published their findings in the Journal of the American Geriatrics Society.

The researchers sent questionnaires to 6,346 older adults who had been diagnosed with heart failure; 2,692 participants returned the questionnaires and were included in the study. Continue reading

Are High-Risk Anticholinergic Medicines Prescribed Too Often for Older Adults?

Journal of the American Geriatrics Society Research Summary

Anticholinergics are a class of medications that are often prescribed for allergies, lung disease, and urinary incontinence. They also often can increase health risks for older adults. These medicines can affect your memory and ability to think, and they can even lead to increases in the risk for falls, dementia, and death. Additionally, older adults often have a difficult time tolerating anticholinergics because of age-related physical changes, such as reduced liver and kidney function, and because medications can impact our brain chemistry more strongly as we age.

Experts use tools to help older adults and healthcare professionals understand the risks associated with medications like anticholinergics. One of these tools is the AGS Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. The AGS Beers Criteria details medications with risks that may outweigh their benefits for older adults. The AGS Beers Criteria identifies 52 “high-risk” anticholinergics. Thirty-five of these are included on a list of medications worth avoiding altogether for older people, unless a healthcare professional has a compelling reason for prescribing them on a case-by-case basis.

Recently, a team of researchers decided to study how frequently healthcare providers prescribe potentially inappropriate medications like anticholinergics in light of recommendations like those from the AGS Beers Criteria. Their study was published in the Journal of the American Geriatrics Society. Continue reading